The BI-RADS v2025 Manual formally incorporates nonmass lesions into the breast ultrasound lexicon. Until now the ultrasound lexicon was built around discrete masses, and abnormalities without a margin or shape had no agreed way of being described — so they were reported inconsistently, or not at all.
The new descriptors classify these lesions by distribution — segmental, linear, focal or regional — alongside echo pattern, posterior features and associated findings. This pictorial review works through pathologically confirmed cases across benign, high-risk and malignant diagnoses, sets out multimodality correlation with mammography, MRI, contrast-enhanced mammography and FDG PET/CT, and addresses the pitfalls that matter most in screening. The central clinical statement is that nonmass lesions carry an overall high malignancy rate that warrants tissue diagnosis.
That is the change to act on. A segmental hypoechoic area with no discrete margin has often been managed as a short-interval follow-up because there was no category for it; under v2025 it is a describable finding with an expectation of biopsy. In India, where handheld ultrasound does a large share of the diagnostic work in dense breasts and where mammographic correlation is not always available, this is the lexicon change most likely to alter what happens to a patient.
- Adopt the v2025 distribution descriptors — segmental, linear, focal, regional — in reports now
- Do not default a nonmass lesion to short-interval follow-up; the expectation is tissue diagnosis
- Correlate with mammography and MRI before deciding, and say in the report what correlation was available
- Brief sonographers on the acquisition pitfalls: positioning, transducer orientation, plane
- Start recording these findings consistently — systematic data on them does not yet exist
Why it matters
A finding that previously had no name and therefore no pathway now has both, and the pathway is tissue.
Don't overread it
This is a pictorial review introducing a lexicon change; the 'high malignancy rate' is a general statement, not a pooled figure from this article.
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